臺灣博碩士論文加值系統

研究目的主要是評估重症肺炎病童之醫師病人量與治療結果兩者間的關係。工具與方法：以2006-2009年台灣健保資料庫為基礎，作回顧性資料分析研究。主要年齡3個月大到滿17歲，入院診斷肺炎，並且住到加護病房的患童為收案對象；總共收案9,754筆患童資料，相對應1,042位主治醫師；將9,754筆資料分成四組評估主治醫師累積的病人量。結果：我們發現，超高量組與其他三組比較，有較短的住院時間、較低的院內死亡率、較低的住院成本，超高量組加護病房天數佔總住院天數比例較其他三組高(p <0.001)。隨著醫師病人量的累積愈高時，其死亡率有下降的趨勢。超高量組的危險因子調整的院內死亡勝算率（risk-adjusted odds ratio; aOR）是0.48 (95% 信賴區間，0.35- 0.65; p <0.001)。結論是醫師重症肺炎患童量較高時，會有較短的住院時間、較低的院內死亡率及醫療成本。

Purpose: The aim of this study is to examine the relationship between physician case volume and the outcomes of critically ill children with pneumonia.
Materials and Methods: This is a population-based cohort study analyzed data provided from the National Health Insurance Research Database of Taiwan, 2006-2009. Children (aged 3 months to 17 years) having records of intensive care unit (ICU) admission and a diagnosis of pneumonia were included. A total of 9754 critically ill children and 1042 attending physicians were enrolled. The children were assigned to 1 of 4 groups based on the physician’s pneumonia case volume.
Results: The patients in the very-high case volume group had a significantly lower length of hospital stay, in-hospital mortality rate, and hospitalization expenses, and a significantly higher ratio of ICU to hospital stays than other 3 groups (p < 0.001). The probability of death tended to be lower when the physician’s case volume was higher. The risk-adjusted odds ratio for in-hospital mortality of very–high case volume group was 0.48(95% confidence interval, 0.35-0.65; p < 0.001) compared to low case volume group.
Conclusions: A higher physician’s pneumonia case volume is associated with a lower length of hospital stay, lower in-hospital mortality rate, and lower hospitalization expenses among critically ill children with pneumonia.

目 錄
誌謝………………………………………………………………………………………………… i
中文摘要………………………………………………………………………………………… iii
英文摘要………………………………………………………………………………………… iv
目錄………………………………………………………………………………………………… v
圖目錄……………………………………………………………………………………………… vi
表目錄……………………………………………………………………………………………… vii
第一章 緒言……………………………………………………………1
第二章 文獻回顧…………………………………………………4
第三章 研究工具與方法…………………………………9
第一節　資料收集…………………………………………………10
第二節　研究對象…………………………………………………11
第三節　醫師病人量……………………………………………13
第四節　統計分析…………………………………………………14
表與圖……………………………………………………15
第四章 結果…………………………………………………………16
表與圖………..……………………………………21
第五章 討論…………………………………………………………30
第六章 結論…………………………………………………………37
參考文獻……………………………………………………………………39
附錄………………………………………………………………………………45
一、台灣行政院衛生署國民健康年報表歷年肺炎死亡資料
二、同意臨床試驗證明書
三、國際臨床診斷碼第九版
四、醫師執照類別人數表
五、英文論文接受函
六、英文論文刊登摘要

圖目錄
圖1.流程圖……………………………………………………………………………………15
圖2. 病人累積量之醫師人數分佈………………………………………21
圖3. 醫師肺炎病人量與病人死亡勝算關係圖………………29

表目錄
表1. 2006-2009年在兒童加護病房肺炎病危患童資料……………………………22
表2-1. 2006-2009年兒童加護病房肺炎病危患童四組醫師資料…………23
表2-2. 2006-2009年兒童加護病房重症肺炎病童四組特性…………………24
表3. 2006-2009年兒童加護病房醫師重症肺炎病童量四組的結果………25
表4. 單變數邏輯斯迴歸分析有關肺炎病危病童院內死亡率危險因子…26
表5-1. 肺炎病危患童院內死亡率…………………………………………………………………………27
表5-2. 肺炎病危患童院內死亡率勝算比……………………………………………………………28

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